Laparo-suture needle and method for use thereof

ABSTRACT

A laparo-suture needle and method for use thereof. A medical suturing instrument employs an outer, hollow shaft having a laterally-disposed, elongate handle at a proximal end and an elongate, inner shaft disposed within the outer shaft. The inner shaft has a cutting edge at the distal end and extends out of the outer shaft at the proximal end, terminating in a spring-loaded push button. A lateral notch is formed in the inner shaft proximal of the cutting edge. The spring forces the inner shaft rearwardly so as to pull the notch within the outer shaft. By gripping the handle and placing pressure on the push button, the inner shaft is moved forward so as to expose the notch. A suture may then be placed in the notch so that the instrument grips the suture between the outer shaft and the inner shaft when the push button is released. The instrument is used for suturing muscle at an incision by gripping the end of a suture, forcing the distal end of the instrument beneath the epidermis within an incision, into the fatty tissue and through the muscle adjacent one side of the incision to force the suture through the muscle.

This is a continuation of application Ser. No. 07/944,205 filed Sep. 10,1992 now U.S. Pat. No. 5,387,227.

BACKGROUND OF THE INVENTION

This invention relates to instruments and methods for suturing tissue,particularly for suturing abdominal (laparo) muscle tissue and thelining of the abdominal cavity following abdominal, especiallylaparoscopic, surgery.

In performing laparoscopic surgery, it is necessary to make an incisionthrough several layers of tissue. They are the outer layer of skin, orepidermis, a layer of fat beneath the epidermis, a layer of abdominalmuscle tissue beneath the fat and the lining of the abdominal cavity,called the peritoneum. Once the procedures within the abdomen arecomplete, it is necessary to close the wound resulting from theincision. This has customarily been done merely by suturing the incisionthrough the layer of epidermis. Closure of the skin does not close themuscle or the peritoneum. While the muscle and peritoneum willeventually heal, it is possible for the intestinal and fatty contents ofthe cavity to protrude through the opening thereby creating a hernia.Closure of the muscle and peritoneum eliminates such risk.

Therefore, it is desirable first to suture the peritoneum and the layerof abdominal muscle and thereafter to suture the layer of epidermis.However, this is difficult to accomplish with a conventional sutureneedle, even a curved suture needle, because the incision in the skin issmall. Exposure of the incision in the muscle requires making the skinincision several times larger, defeating the concept of minimalinvasion. It is difficult to manipulate a standard needle into the edgesof the underlying muscle through the small incision in the skin andunderlying fat tissue.

Accordingly, there is a need for an improved medical instrument andmethod for suturing the abdominal muscle tissue and peritoneum at anincision therethrough.

SUMMARY OF THE INVENTION

The present invention meets the aforementioned need and solves theaforementioned problems by providing a novel and improved medicalinstrument for suturing muscle tissue, particularly the abdominal muscletissue together with the peritoneum. It employs an outer, hollow shafthaving a laterally-disposed, elongate handle at a proximal end and anelongate, inner shaft disposed within the outer shaft. The inner shaftis solid, but flexible, and has a cutting edge at a distal end. Itextends out of the outer shaft at the proximal end, terminating in aspring-loaded push button. A lateral notch is formed in the inner shaftadjacent the cutting edge. Ordinarily, the spring forces the inner shaftrearwardly so as to pull the notch within the outer shaft. By grippingthe handle and placing pressure on the push button, the inner shaft ismoved forward so as to expose the notch. A suture may then be placed inthe notch so that the instrument pulls the suture inside the outer shaftand grips the suture between the outer shaft and the inner shaft whenthe push button is released.

The instrument is used by placing a suture into the notch, securing itby retracting the notch into the outer shaft, and forcing the needlethrough the fascia, muscle and peritoneum into the abdominal cavity. Thesuture is then grasped by another grasping instrument, such as graspingforceps, inserted into the abdominal cavity through another incision,and the suture is released from the notch by extending the inner shaftso as to move the notch forward out of the sheath. The instrument isthen removed from the wound and reinserted on the opposite side of themuscle incision in the same way, except the instrument is empty. Thesuture previously passed through the muscle is grasped by theinstrument, which is then removed from the incision, bringing the suturewith it.

Therefore, it is a principle object of the present invention to providea novel and improved suturing instrument and suturing method.

It is another object of the present invention to provide a suturinginstrument which facilitates suturing the abdominal muscle tissue andperitoneum at an incision.

It is a further object of the present invention to provide a suturinginstrument which facilitates manipulation of a suture inside the abdomenof a patient so as to guide the suture through muscle tissue on one sideof an incision, grasp it within the abdomen, and pull it out throughmuscle tissue on the other side of the incision.

It is yet another object of the present invention to provide a method ofmanipulating a suture through the abdominal muscle, into the abdominalcavity, without enlarging the associated skin incision solely for thepurpose of manipulating needles to suture the muscle layers of theincision.

The foregoing and other objects, features and advantages of theinvention will be more readily understood upon consideration of thefollowing detailed description of the invention, taken in conjunctionwith the accompanying drawings.

BRIEF DESCRIPTION OF THE DRAWINGS

FIG. 1 shows a side view of a medical instrument according to thepresent invention, in partial section.

FIG. 2 shows a side view of a medical instrument according to thepresent invention with an inner shaft thereof forced to its forwardposition.

FIG. 3 shows a side view of the tip of an inner shaft of a medicalinstrument according to the present invention from a side facing thecutting edge thereof.

FIG. 4A shows a perspective view of a medical instrument according tothe present invention, and the preferred method for use thereof to closean abdominal wound according to the present invention.

FIG. 4B shows a perspective view of the abdominal wound of FIG. 4Afollowing use of the medical instrument according to the presentinvention to place one loop of a suture at the wound.

DESCRIPTION OF THE PREFERRED EMBODIMENT

Referring first to FIG. 1, a preferred embodiment of a medicalinstrument 10 according to the present invention comprises a needlehaving a first, elongate, hollow, outer shaft 12 and a second, innershaft 14 disposed within the outer shaft 12, the inner shaft 14 having asharp point 16 disposed at the distal end 18 thereof and beinglongitudinally movable within the outer shaft. The outer shaft serves asa sheath for the inner shaft.

An operating means is provided at the proximal end of the outer shaftfor moving the inner shaft forward and backward. Preferably, the innerand outer shafts each have cylindrical cross sections, though it is tobe recognized that other shapes could be employed without departing fromthe principles of the invention. The operating means comprises a pushbutton 22 for moving the inner shaft forward relative to the outershaft, thereby activating the instrument, and a spring 24 for returningthe inner shaft to a rearward position once the push button is released.The limit of the rearward position to which the shaft is returned whenthe instrument is not activated is determined by the length of thespring when it is not compressed.

The inner shaft is provided with a lateral notch 26 spaced a distance dproximally from the sharp point 16 of the inner shaft, the purpose ofmoving the inner shaft forward relative to the outer shaft 12 being toexpose the notch 26, as shown in FIG. 2. Preferably, the notch has arectangular shape of predetermined width w, as shown in FIGS. 1 and 2.The distance d and the width w of the notch are chosen so that when thepush button is released the notch is drawn entirely within the outershaft, or sheath, and when the push button is fully depressed, the notchis entirely exposed.

In addition, a handle 28 is connected to the distal end of the outershaft 12 to enable the user to grip the instrument. The handle is in theshape of an elongate, rectangular prism disposed symmetrically about theproximal end of the outer shaft 12. Also, the handle 28 is provided witha pair of proximally concave indentations 30 and 32, respectively,disposed on opposite sides of the shaft 12. That is, the distal side ofthe handle is indented in the proximal direction. These permit the userto place two fingers in the respective concave indentations and thethumb of the same hand of the user on the end of the push button 22 tomanipulate the instrument. By pressing down on the thumb, the innershaft is extended to expose the notch 26, thereby activating theinstrument.

Turning to FIG. 3, as well as FIGS. 1 and 2, the sharp point preferablyis formed by a cutting edge 34 extending from the distal tip of theshaft 14 along one side thereof rearwardly toward the proximal end ofthe shaft. The cutting edge may be formed by grinding the end of theinner shaft 14 to achieve the shape shown in FIGS. 1, 2 and 3.

Preferably, the inner shaft 14 is substantially solid clear through andmade of a flexible metal suitable for surgical use. However, it is to berecognized that the shaft 14 need not be entirely solid, provided thatit has sufficient rigidity and resiliency that it will flex to fit intoposition for use, yet return to its original shape and transmit adequateforce from its proximal end to its distal end to cut and be pushedthrough the abdominal muscle. The outer shaft primarily serves as asheath for the notch 26, and is preferably made of a suitable flexiblematerial, such as plastic, so as to deform to allow a suture placed inthe notch to be pulled into the outer shaft by the inner shaft. If theouter shaft material is relatively thick, as may be the case whereplastic is used, the outer shaft should preferably have a taper 19 atthe distal end to facilitate forcing the instrument through tissue.

It is to be recognized that other materials, a different type of handleand a different type of operating means for moving the inner shaftforward and backward may be used without departing from the principle ofthe invention.

The method of use of the instrument 10 is illustrated in FIGS. 4A and4B. In those figures, an incision 36 in the abdomen 38 of a patient isshown. Along one side 40 of the incision four layers of tissue can beseen, that is, the epidermis 42, a layer of fat 44, a layer of muscle 46and the peritoneum 47. The upper edge 48 of the epidermis is shown onthe opposite side of the incision, along with the upper edge 50 andlower edge 51 of the muscle, by hidden lines.

Referring first to FIG. 4A, in use of the instrument, the distal end 18is forced beneath the epidermis 42, into the fatty tissue 44 and throughthe muscle 46 and peritoneum 47, as shown at 52. The sharp point 16starts a cut through the muscle tissue and peritoneum, which iscompleted by the cutting edge 34, providing a small opening adequate forreceiving the outer shaft 12. Typically, the user would place a thumb orother finger on the push button 22 to keep the inner shaft 14 from beingpushed further back into the outer shaft 12.

Referring back to FIGS. 1 and 2, in the first instance the push button22 is depressed as shown in FIG 2. A suture, such as suture 53 shown inFIG. 4A, is then placed in the notch 26. Thereafter, the push button 22is released so that the spring 24 draws the inner shaft backward throughthe outer shaft 12 until the suture 52 is pulled back into the outershaft 14 and gripped between the inner shaft 14 and the outer shaft 12,as shown in FIG. 4. It is to be recognized that, in FIG. 4A, the sutureis shown gripped inside the abdomen, as explained hereafter, but thatinitially the suture would be gripped outside the abdomen to begin thesuturing process.

Once the suture is gripped by the instrument, the instrument is forcedthrough the muscle tissue 46, as previously explained, at a startingpoint for suturing the muscle. In FIG. 4A that starting point is shownat 54, where the suture 53 runs through the muscle tissue. Indeed,forcing the instrument 10 through the muscle tissue 46 also guides thesuture through the resulting opening.

More specifically, the instrument is used as follows. After placing asuture 53 into the notch 26 and securing it by retracting the notch intothe outer shaft, the instrument is grasped by the handle 28. The pointedend of the needle is placed through the incision in the skin andunderlying fat, engaging the facial covering of the muscle on one sideof the incision. Sufficient pressure is applied to force the needlethrough the fascia, muscle and peritoneum into the abdominal cavity. Thesuture 53 is then grasped by another grasping instrument 55, such asgrasping forceps, inserted into the abdominal cavity through anotherincision, and the suture is released from the notch by extending theinner shaft so as to move the notch forward out of the sheath. Theinstrument is then removed from the wound, leaving the suture in placeat 54 in FIG. 4A.

Thereafter, the instrument is reinserted on the opposite side of themuscle incision at 52 in FIG. 4A in the same way, except that theinstrument is empty. The suture previously passed through the muscle,and now being held by the separate grasping instrument, is placed intothe notch by the separate grasping instrument. The push button of theinstrument is pressed to expose its notch 26, which is manipulated overthe suture inside the abdomen, and the push button is released to gripthe suture inside the abdomen, as shown in FIG. 4A. The instrument isthen removed from the incision, bringing the suture with it. The suturehas thereby been placed through the desired tissues and both ends exitthe skin incision so that the suture is ready to be tied, as shown inFIG. 4B.

It is to be recognized that, while the procedure described above is thepreferred method of using the instrument, variations in these stepsmight be used without departing from the principles of the invention.

The terms and expressions which have been employed in the foregoingspecification are used therein as terms of description and not oflimitation, and there is no intention in the use of such terms andexpressions of excluding equivalents of the features shown and describedor portions thereof, it being recognized that the scope of the inventionis defined and limited only by the claims which follow.

I claim:
 1. A method for suturing tissue of a patient at the site of awound, comprising the steps of:(a) attaching a suture to a needle havinga distal end and a proximal end gripping means adjacent said distal endand reciprocating means included in said needle for actuating saidgripping means to grip said suture, said suture being attached to saidneedle by said gripping means; (b) forcing said needle through tissueadjacent a first side of the wound so as to guide said suturetherethrough; (c) after said suture has been guided through said tissuein step (b), releasing said suture from said needle using saidreciprocating means; (d) withdrawing said needle from said tissueadjacent said first side of the wound after said suture has beenreleased in step (c); (e) forcing said needle through tissue adjacent asecond side of the wound and gripping said suture within the body of thepatient using said needle; and (f) withdrawing said needle from saidtissue adjacent said second side of the wound so as to guide said suturefrom within the body of the patient therethrough, wherein steps (a)through (f) are repeated until the tissue at the wound is substantiallyclosed, the portion of said suture guided through said tissue in step(f) thereafter being guided through said tissue in step (a).
 2. A methodfor suturing tissue of a patient at the site of a wound, comprising thesteps of:(a) attaching a suture to a needle having a distal end and aproximal end, gripping means adjacent said distal end and reciprocatingmeans included in said needle for actuating said gripping means to gripsaid suture, said suture being attached to said needle by said grippingmeans; (b) forcing said needle through tissue adjacent a first side ofthe wound so as to guide said suture therethrough; (c) after said suturehas been guided through said tissue in step (b), releasing said suturefrom said needle using said reciprocating means; (d) forcing throughtissue adjacent a second side of the wound a needle having a distal endand a proximal end, gripping means adjacent the distal end andreciprocating means included in said needle for actuating said grippingmeans to grip said suture, wherein said needles comprise: an elongate,hollow first shaft having a proximal end and a distal end; an elongatesecond shaft having a proximal end and a distal end and being disposedinside said first shaft, said needle having a sharp distal portion forpiercing tissue; a lateral notch having an open portion disposed in saidsecond shaft a predetermined distance proximally from said distal endthereof for receiving said suture; reciprocating means included in saidneedle for moving said second shaft relative to said first shaft suchthat said notch and suture can be moved within said first shaft so as tosecure said suture in said notch between said first shaft and saidsecond shaft, said reciprocating means including a tension memberinterconnecting said first and second shafts so as to bias said firstand second shafts in predetermined positions relative to one another,and when said notch is in its distal most position entirely within saidfirst shaft, said sharp distal portion of said needle can pierce thetissue and carry said suture therethrough; (e) gripping said suturewithin the body of the patient using said needle used in step (d); and(f) withdrawing said needle used in step (e) from said tissue adjacentsaid second side of the wound so as to guide said suture from within thebody of the patient therethrough.
 3. The method of claim 2, wherein saidtension member is a spring disposed so as to bias said second shaft sothat said open portion of said notch is blocked by said first shaft, inthe absence of engagement of said reciprocating means.
 4. The method ofclaim 3, wherein said reciprocating means includes actuation means forapplying forward force on said second shaft relative to said first shaftto move said first shaft forward to unblock said open portion of saidnotch.
 5. The method of claim 2, wherein said notch is rectangular.
 6. Amethod for suturing tissue of a patient at the site of a wound,comprising the steps of:(a) attaching a suture to a needle having adistal end and a proximal end, gripping means adjacent said distal endand reciprocating means included in said needle for actuating saidgripping means to grip said suture, said suture being attached to saidneedle by said gripping means; (b) forcing said needle through tissueadjacent a first side of the wound so as to guide said suturetherethrough; (c) after said suture has been guided through said tissuein step (b), releasing said suture from said needle using saidreciprocating means; (d) forcing through tissue adjacent a second sideof the wound a needle having a distal end and a proximal end, grippingmeans adjacent said distal end and reciprocating means included in saidneedle for actuating said gripping means to grip said suture, whereinsaid needles comprise: an elongate, hollow first shaft having a proximalend and a distal end; an elongate second shaft having a proximal end anda distal end and being disposed inside said first shaft, said needlehaving a sharp distal portion for piercing tissue; a lateral notchhaving an open portion disposed in said second shaft a predetermineddistance proximally from said distal end thereof for receiving saidsuture; a cutting edge disposed on said needle distally of said notch;reciprocating means included in said needle for moving said second shaftrelative to said first shaft such that said notch and suture can bemoved within said first shaft so as to secure said suture in said notchbetween said first shaft and said second shaft, said reciprocating meansmaintaining said first and second shafts in predetermined positionsrelative to one another, and when said notch is in its distal mostposition entirely within said first shaft, said sharp distal portion ofsaid needle can pierce the tissue and carry said suture therethrough;(e) gripping said suture within the body of the patient using saidneedle used in step (d); and (f) withdrawing said needle used in step(e) from said tissue adjacent said second side of the wound so as toguide said suture from within the body of the patient therethrough. 7.The method of claim 6, wherein said reciprocating means furthercomprises a tension member interconnecting said first and second shaftsso as to bias said first and second shafts into said predeterminedposition relative to one another.
 8. The method of claim 7, wherein saidtension member is disposed so as to provide backward force on saidsecond shaft relative to said first shaft.
 9. The method of claim 8,wherein said tension member is a spring adapted and disposed so as tobias said second shaft so that said open portion of said notch isblocked by said outer shaft, in the absence of engagement of saidoperating means.
 10. The method of claim 9, wherein said reciprocatingmeans includes actuation means for applying forward force on said secondshaft relative to said first shaft to move said first shaft forward tounblock said open portion of said notch from said first shaft.
 11. Themethod of claim 6, wherein said notch is rectangular.
 12. A method forsuturing tissue of a patient at the site of a wound, comprising thesteps of:(a) attaching a suture to a needle having a distal end and aproximal end, gripping means adjacent said distal end and reciprocatingmeans included in said needle for actuating said gripping means to gripsaid suture, said suture being attached to said needle by said grippingmeans, wherein said needle comprises: an elongate, hollow first shafthaving a proximal end and a distal end; an elongate second shaft havinga proximal end and a distal end and being disposed inside said firstshaft, said needle having a sharp distal portion for piercing tissue; alateral notch having an open portion disposed in said second shaft apredetermined distance proximally from said distal end thereof forreceiving said suture; reciprocating means included in said needle formoving said second shaft relative to said first shaft such that saidnotch and suture can be moved within said first shaft so as to securesaid suture in said notch between said first shaft and said secondshaft, said reciprocating means including a tension memberinterconnecting said first and second shafts so as to bias said firstand second shafts in predetermined positions relative to one another,and when said notch is in its distal most position entirely within saidfirst shaft, said sharp distal portion of said needle can pierce thetissue and carry said suture therethrough; (b) forcing said needlethrough tissue adjacent a first side of the wound so as to guide saidsuture therethrough; (c) after said suture has been guided through saidtissue in step (b), releasing said suture from said needle using saidreciprocating means; (d) gripping said suture within the body of thepatient using a separate gripping means inserted into the body; and (f)withdrawing said needle from said tissue adjacent said first side of thewound.
 13. The method of claim 12, wherein said tension member is aspring disposed so as to bias said second shaft so that said openportion of said notch is blocked by said first shaft, in the absence ofengagement of said reciprocating means.
 14. The method of claim 13,wherein said reciprocating means includes actuation means for applyingforward force on said second shaft relative to said first shaft to movesaid first shaft forward to unblock said open portion of said notch. 15.A method for suturing tissue of a patient at the site of a wound,comprising the steps of:(a) attaching a suture to a needle having adistal end and a proximal end, gripping means adjacent said distal endand reciprocating means included in said needle for actuating saidgripping means to grip said suture, said suture being attached to saidneedle by said gripping means, wherein said needle comprises anelongate, hollow first shaft having a proximal end and a distal end; anelongate second shaft having a proximal end and a distal end and beingdisposed inside said first shaft, said needle having a sharp distalportion for piercing tissue; a lateral notch having an open portiondisposed in said second shaft a predetermined distance proximally fromsaid distal end thereof for receiving said suture; reciprocating meansincluded in said needle for moving said second shaft relative to saidfirst shaft such that said notch and suture can be moved within saidfirst shaft so as to secure said suture in said notch between said firstshaft and said second shaft, said reciprocating means including atension member interconnecting said first and second shafts so as tobias said first and second shafts in predetermined positions relative toone another, and when said notch is in its distal most position entirelywithin said first shaft, said sharp distal portion of said needle canpierce the tissue and carry said suture therethrough; (b) forcing saidneedle through tissue adjacent a first side of the wound so as to guidesaid suture therethrough; (c) after said suture has been guided throughsaid tissue in step (b), releasing said suture from said needle usingsaid reciprocating means; (d) withdrawing said needle from said tissueadjacent said first side of the wound after said suture has beenreleased in step (c); (e) forcing said needle through tissue adjacent asecond side of the wound and gripping said suture within the body of thepatient using said needle; and (f) withdrawing said needle from saidtissue adjacent said second side of the wound so as to guide said suturefrom within the body of the patient therethrough.
 16. The method ofclaim 15, wherein said tension member is a spring disposed so as to biassaid second shaft so that said open portion of said notch is blocked bysaid first shaft, in the absence of engagement of said reciprocatingmeans.
 17. The method of claim 16, wherein said reciprocating meansincludes actuation means for applying forward force on said second shaftrelative to said first shaft to move said first shaft forward to unblocksaid open portion of said notch.
 18. A method for suturing tissue of apatient at the site of a wound, comprising the steps of:(a) attaching asuture to a needle having a distal end and a proximal end gripping meansadjacent said distal end and reciprocating means included in said needlefor actuating said gripping means to grip said suture, said suture beingattached to said needle by said gripping means, wherein said needlecomprises: an elongate, hollow first shaft having a proximal end and adistal end; an elongate second shaft having a proximal end and a distalend and being disposed inside said first shaft, said needle having asharp distal portion adapted for piercing tissue; a lateral notch havingan open portion disposed in said second shaft a predetermined distanceproximally from said distal end thereof for receiving said suture; acutting edge disposed on said needle distally of said notch;reciprocating means included in said needle for moving said second shaftrelative to said first shaft such that said notch and suture can bemoved within said first shaft so as to secure said suture in said notchbetween said first shaft and said second shaft, said reciprocating meansmaintaining said first and second shafts in predetermined positionsrelative to one another, and when said notch is in its distal mostposition entirely within said first shaft, said sharp distal portion ofsaid needle can pierce the tissue and carry said suture therethrough;(b) forcing said needle through tissue adjacent a first side of thewound so as to guide said suture therethrough; (c) after said suture hasbeen guided through said tissue in step (b), releasing said suture fromsaid needle using said reciprocating means; (d) gripping said suturewithin the body of the patient using a separate gripping means insertedinto the body; and (f) withdrawing said needle from said tissue adjacentsaid first side of the wound.
 19. The method of claim 18, wherein saidreciprocating means further comprises a tension member interconnectingsaid first and second shafts so as to bias said first and second shaftsinto said predetermined position relative to one another.
 20. The methodof claim 19, wherein said tension member is disposed so as to providebackward force on said second shaft relative to said first shaft. 21.The method of claim 20, wherein said tension member is a spring adaptedand disposed so as to bias said second shaft so that said open portionof said notch is blocked by said outer shaft, in the absence ofengagement of said operating means.
 22. A method for suturing tissue ofa patient at the site of a wound, comprising the steps of:(a) attachinga suture to a needle having a distal end and a proximal end, grippingmeans adjacent said distal end and reciprocating means included in saidneedle for actuating said gripping means to grip said suture, saidsuture being attached to said needle by said gripping means, whereinsaid needle comprises an elongate, hollow first shaft having a proximalend and a distal end; an elongate second shaft having a proximal end anda distal end and being disposed inside said first shaft, said needlehaving a sharp distal portion adapted for piercing tissue; a lateralnotch having an open portion disposed in said second shaft apredetermined distance proximally from said distal end thereof forreceiving said suture; a cutting edge disposed on said needle distallyof said notch; reciprocating means included in said needle for movingsaid second shaft relative to said first shaft such that said notch andsuture can be moved within said first shaft so as to secure said suturein said notch between said first shaft and said second shaft, saidreciprocating means maintaining said first and second shafts inpredetermined positions positions relative to one another, and when saidnotch is in its distal most position entirely within said first shaft,said sharp distal portion of said needle can pierce the tissue and carrysaid suture therethrough; (b) forcing said needle through tissueadjacent a first side of the wound so as to guide said suturetherethrough; (c) after said suture has been guided through said tissuein step (b), releasing said suture from said needle using saidreciprocating means; (d) withdrawing said needle from said tissueadjacent said first side of the wound after said suture has beenreleased in step (c); (e) forcing said needle through tissue adjacent asecond side of the wound and gripping said suture within the body of thepatient using said needle; and (f) withdrawing said needle from saidtissue adjacent said second side of the wound so as to guide said suturefrom within the body of the patient therethrough.
 23. The method ofclaim 22, wherein said reciprocating means further comprises a tensionmember interconnecting said first and second shafts so as to bias saidfirst and second shafts into said predetermined position relative to oneanother.
 24. The method of claim 23, wherein said tension member isdisposed so as to provide backward force on said second shaft relativeto said first shaft.
 25. The method of claim 24, wherein said tensionmember is a spring adapted and disposed so as to bias said second shaftso that said open portion of said notch is blocked by said outer shaft,in the absence of engagement of said operating means.